Provider Demographics
NPI:1760578710
Name:FILIPS, MONIQUE ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:ANN
Last Name:FILIPS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:MONIQUE
Other - Middle Name:ANN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2842 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2803
Mailing Address - Country:US
Mailing Address - Phone:310-325-0800
Mailing Address - Fax:310-325-7705
Practice Address - Street 1:2842 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2803
Practice Address - Country:US
Practice Address - Phone:310-325-0800
Practice Address - Fax:310-325-7705
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4948225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16657Medicare UPIN